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�8t@�'_�' I Pu�lm Woris Permil a `�� / `� I <br /> Application For em� o�pi.+���JJr(Q�_ <br /> F'U�L.IC WOR�CS PERIVIIT ������,vo«�F�� — I <br /> m�n�Fae s I <br /> Luss Appl.Fce PaN S <br /> Print or Type Or.ly o�����eo�� S z�� <br /> /LICLh!/G� �OhS"�"YbG��o� �, rti�. aois=� y��s� i'�el/hyloqtyi �??ZS G7/—y/`�� ' <br /> Owner Mailing Address City Zip Phone '� <br /> S�l�12 <br /> Applicant Mailieg >ddress City Zip Phcne <br /> Describe Proposed Work � �in 4l� fq'���N ��YS�CJ'PN( e <br /> �/ �/ � <br /> (Q �v�.'fSPh �Q`'�C. <br /> Project AdCress(if known� �Ql 2T— �� �/�./�.G', r� � <br /> � <br /> Altach four(4) copies ol plans lor proposed work� Draw to scale and note ihe following as applicable: ia <br /> • Property Lines • Centerline ol street � <br /> • OuNine and dimensions of all exisling and 9 Indic�te Nor�h <br /> proposed s�ructures on the lot ! Sho�v any proposed gradiny chan9es <br /> • [xisling �nd proposed utilities • Shnw measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls(or inspection shall be made 24 h�s.in advance- phone 259-8810. � , <br /> 2.All work shall be performed in accordancr vei�h this permit�nd current City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3 C�II Location Under�round Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> i •i <br /> , , . .... , . _ i_�� , <br /> ;� ��UL•r IC �h'ATItiAGE cYcTr_p� /.�c F�;n��r�F^ � .iF:� ._ � <br /> Y !. O i r,fi;1nE i;H/�f�IGi t � _ _ � <br /> �PL.7C �n�0i;k':,��' TI•ILiF'ECT�'.i � <br /> FF� C?'I'Y SI'I�FI. TS 1 � �� <br /> 19TriLl. I�./11'I I' J C+.:;;:c I-0 I�i diLit iy`f 1 :-.: � <br /> i � : ' '" _, ' ' _ �:: <br /> ACKNOWLEDGEMENT OF CONDITION; <br /> _ The undersigned owner/applicant hereby agrees�o hoid and save h:.irnr <br /> less the City ol Everett froin any and alt cla(ms for d.�mages. cosis. <br /> expenses, or causes of action thot may arise Lecause of installation <br /> C_. ` Q �� � �_r� and mam�enance of �he iniprovement or olher ryi:+-of-wav use hereto <br /> � applied lor and furiher ac�rees to remove same upon notice liom �hc <br /> f�pproved for Cons�ruclio Da�e City and to replace publi roper�y damaged thereby. <br /> i <br /> FINAL INSPECTION Da�e �'1�S dC�Id �Il � — <br /> Approved as Constructed Sig ��� ue ol Applic nt Datc <br /> [�vr.rctt PUBLIC WORKS UEPARTMENT WORfi AUTHORIZED BY TH�.S PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATF PERMIT IS ISSUED AND THEFEAFTER IS TC <br /> Everett,WA9E120t BE DIJGENTLY PURSUED TO COMPLFTION. THIS PERMIT MAY EtE <br /> Pnone 259-8810 CANCE�t ED BY THE CITY UPON ANY STOPPAGE OF'JVORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />